Provider Demographics
NPI:1912034984
Name:SMITH, S. SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:S. SCOTT
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9695 S YOSEMITE ST STE 224
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-2890
Mailing Address - Country:US
Mailing Address - Phone:303-265-3970
Mailing Address - Fax:303-265-3971
Practice Address - Street 1:9695 S YOSEMITE ST STE 224
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2890
Practice Address - Country:US
Practice Address - Phone:303-265-3970
Practice Address - Fax:303-265-3971
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2710207R00000X
FLME155336207R00000X
CO38479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-007OtherTRICARE
TX342522501Medicaid
CO43302815Medicaid
TXP01443279OtherRAIL ROAD MEDICARE
TX75-2616977-118OtherTRICARE
TX8EW546OtherBCBS
TX75-2616977-066OtherTRICARE
COH27019Medicare UPIN
COCOAAA1688Medicare PIN
TX75-2616977-118OtherTRICARE
COCK11003Medicare PIN